Chronic Pain Initiative

Due to the steady high volume of orthopedic specialty care referrals for the “Gateway to Better Health” program since its inception in 2012, the St. Louis Regional Health Commission (RHC) called for an orthopedic referral analysis in August 2016. The corresponding report, Orthopedic Referral Study: Assessment of Current Practices and Recommendations Regarding the Care of Patients with Musculoskeletal Problems, was approved by the RHC in August 2017. Key findings included 1) the high prevalence of musculoskeletal chronic pain (pain lasting 3 months or longer) and 2) the multifaceted opportunities to improve chronic pain treatment and prevention for patients in the St. Louis safety network.

Subsequent surveys showed that more than half of Gateway patients suffer from chronic pain, which is greater than twice the national average rate of chronic pain among U.S. adults (CDC, 2018). Of the Gateway patients with chronic pain, approximately two-thirds are experiencing pain in multiple locations, and another two-thirds report that their pain affects their ability to seek or maintain employment (GBH Survey Data, 2018).

Due to the high prevalence and impact of chronic pain on the Gateway patient population, in November 2017, the RHC’s two Advisory Boards designated chronic pain as an important regional public health issue, voting to prioritize this topic in 2018-2019. The RHC subsequently approved chronic pain as a key focus area, with the following three deliverables:

A clinical action plan to support patients and providers in the optimal management of chronic pain. The plan will explore implementing the following:

Improved referral process for Gateway to Better Health members to access current specialty care services that prevent and treat chronic pain.

Physical therapy benefit in the Gateway to Better Health program, including a plan for staffing, referral protocol, and a financial model.

Educational campaign, including a training and guidance document, in collaboration with Alive and Well Communities for Missouri providers and patients to manage chronic pain as a chronic disease and to recognize the role of trauma and emotional pain.

Evaluation plan to measure system-wide changes in chronic pain prevention and treatment for the Gateway to Better Health patient population.

A communication plan to drive the implementation of the policy paper and the clinical action plan and to push the following key messaging:

Prevent acute pain from becoming chronic

Treat chronic pain as a chronic disease.

Address chronic pain through a trauma-informed lens.

Through the three deliverables described above, the Chronic Pain Initiative aims to 1) decrease the progression of acute pain to chronic pain for Gateway members and 2) improve the treatment of chronic pain in our region for the Gateway patient population.